The US Food and Drug Administration (FDA) has added 8 drugs to its list of products to monitor because of possible signs of serious risks or new safety information. The agency spotted yellow flags for the 8 drugs in the FDA Adverse Event Reporting System (FAERS) database during April, May, and June 2012.

The agency will study the drug to determine whether there is truly a causal link. The FDA is also not suggesting that clinicians should stop prescribing watch-list drugs, or that patients should stop taking them, according to an agency press release.

Potential signals of serious risks/new safety information identified by FAERS, April to June 2012

Product Name: Active Ingredient (Trade) or Product Class

Potential Signal of a Serious Risk/New Safety Information

Additional Information (as of August 1, 2012)*

Cetirizine HCl (Zyrtec, McNeil)

Oculogyric crisis

Codeine sulfate

Respiratory depression or arrest resulting in death in children taking codeine who are CYP2D6 ultra-rapid metabolizers

Stool softeners, like docusate, act as surfactants to increase the amount of water in stool. A small number of RCTs evaluating docusate have not shown consistent benefit for constipation-related symptoms compared with psyllium or placebo. The evidence that exists suggests that docusate offers little benefit for constipation (Am J Gastroenterol 2005;100:S1-S4).

Carotid neck ultrasound the only way to check regression of heart blockages

Photo Feature (From HCFI Photo Gallery)

19th MTNL Perfect Health Mela to train 10,000 people in compression only CPR

Addressing a press conference, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India said that more than 10,000 members of the public will be certified in compression-only CPR during the Mela.

National News

Polio check: India to focus on 'vulnerable' migrant population

Press Trust of India/New Delhi October 24, 2012: After its removal from the list of polio-endemic nations, India has been told to concentrate on its migrant populations to ensure that no fresh case of wild polio virus is reported in the country. Sharing its information on migrant settlements vulnerable to polio spread, the WHO has asked the Union Health Ministry to concentrate on such areas to heighten its surveillance on migrant population. India will lose its tag of being a polio-free nation once a fresh case is reported till January 2014. The last case of polio was detected on January 13, 2011 in West Bengal. Sources said a large number of such settlements at high risk of wild polio virus transmission have been identified which include construction sites, jhuggi clusters and nomad areas. "Migrant population plays a big role and are at high risk for spread of poliovirus.... They are a big challenge and we are now concentrating on such settlements," said a Health Ministry official. He said the data needs to be updated frequently and "we have mapped them out now" and intimation has been sent to various states for maintaining strict vigil in such areas. Health Ministry officials say the migrant population are most vulnerable to polio spread and such areas need to be focused for polio vaccination under the pulse polio programme. Officials say such vulnerable settlements will now be in focus to help build the immunity of children in such areas. Only three countries in the world are now in the list of polio-endemic nations – Afghanistan, Nigeria and Pakistan, which have never stopped indigenous wild polio virus transmission.

The preferred surgical treatment for severe mitral stenosis is repair (commissurotomy) but mitral valve replacement is often necessary since the valvular morphology in elderly adults is usually unfavorable (extensive calcification, rigidity, and retraction of all of the valve components), making the valve unamenable to commissurotomy.

The Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) voted today to expand the recommendation for the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during pregnancy to encompass all pregnant women regardless of vaccination history, including repeat vaccinations in subsequent pregnancies. (Source: Medscape)

The cardiovascular risk factors of smoking, hypertension, dyslipidemia, and type 2 diabetes each contribute to men's chance of developing significant peripheral artery disease, and together account for most of the risk, a large prospective study showed. (Source: Medpage Today)

Organic foods are essentially no more nutritious than conventionally produced foods, but whether they are safer is still an unanswered question, according to a new policy statement from the American Academy of Pediatrics (AAP) released here during its 2012 National Conference and Exhibition. The new recommendations were presented at a press conference during the meeting and concurrently published online October 22 in the journal Pediatrics. (Source: Medscape)

@DrKKAggarwal: National Workshop on Homeopathy in Cardiology in the forthcoming Perfect Health Mela For the first time, a... http://fb.me/269txYImU

@DeepakChopra: Be kind to yourself and others. Come from love every moment you can. Deepak

Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Cultivating positive thoughts

Darkness present in a room cannot be removed physically. It can only be removed by switching on the light. Darkness therefore can be defined as absence of light. Similarly, negative thoughts can be defined as absence of positive thoughts. It is very difficult to remove negative thoughts but it is very easy to cultivate positive thoughts. Persistent negative thoughts create sympathetic overactivity and leads to lifestyle disorders like blood pressure, acidity, depression, diabetes and heart blockages.

A patient is positioned under a ?uoroscope (a real-time x-ray imager) on a table. The gynecologist or radiologist then examines her uterus and places a speculum in her vagina. Her cervix is cleaned, and a device (cannula) is placed into the opening of the cervix. The physician then gently ?lls the uterus with a liquid containing iodine (contrast) through the cannula. The contrast then enters the tubes, outlines the length of the tubes, and spills out their ends if they are open. Any abnormalities in the uterine cavity or fallopian tubes will be visible on a monitor.

Blood is the red colored fluid in a human, flowing continuously in our body in the circulatory system. Each healthy individual has about 1/12th of his body weight as blood in him. On an average, about 5 liters of blood is present in every human being.

The cheerful girl with bouncy golden curls was almost five. Waiting with her mother at the checkout stand, she saw them: a circle of glistening white pearls in a pink foil box. "Oh please, Mommy. Can I have them? Please, Mommy, please!"

Quickly the mother checked the back of the little foil box and then looked back into the pleading blue eyes of her little girl's upturned face. "A dollar ninety-five. That's almost $2.00. If you really want them, I'll think of some extra chores for you and in no time you can save enough money to buy them for yourself. Your birthday's only a week away and you might get another crisp dollar bill from Grandma."

As soon as Jenny got home, she emptied her penny bank and counted out 17 pennies. After dinner, she did more than her share of chores and she went to the neighbor and asked Mrs. McJames if she could pick dandelions for ten cents. On her birthday, Grandma did give her another new dollar bill and at last she had enough money to buy the necklace.

Jenny loved her pearls. They made her feel dressed up and grown up. She wore them everywhere-Sunday school, kindergarten, even to bed. The only time she took them off was when she went swimming or had a bubble bath. Mother said if they got wet, they might turn her neck green.

Jenny had a very loving daddy and every night when she was ready for bed, he would stop whatever he was doing and come upstairs to read her a story. One night when he finished the story, he asked Jenny, "Do you love me?"

"Oh yes, Daddy. You know that I love you."

"Then give me your pearls."

"Oh, Daddy, not my pearls. But you can have Princess - the white horse from my collection. The one with the pink tail. Remember, Daddy? The one you gave me. She's my favorite."

"That's okay, Honey. Daddy loves you. Good night." And he brushed her cheek with a kiss.

About a week later, after the story time, Jenny's daddy asked again, "Do you love me?"

"Daddy, you know I love you."

"Then give me your pearls."

"Oh Daddy, not my pearls. But you can have my baby doll. The brand new one I got for my birthday.

She is so beautiful and you can have the yellow blanket that matches her sleeper."

"That's okay. Sleep well. God bless you, little one. Daddy loves you." And as always, he brushed her cheek with a gentle kiss. A few nights later when her daddy came in, Jenny was sitting on her bed with her legs crossed Indian-style.

As he came close, He noticed her chin was trembling and one silent tear rolled down her cheek. "What is it, Jenny? What's the matter?"

Jenny didn't say anything but lifted her little hand up to her daddy. And when she opened it, there was her little pearl necklace. With a little quiver, she finally said, "Here, Daddy. It's for you."

With tears gathering in his own eyes, Jenny's kind daddy reached out with one hand to take the dime-store necklace, and with the other hand he reached into his pocket and pulled out a blue velvet case with a strand of genuine pearls and gave them to Jenny. He had had them all the time. He was just waiting for her to give up the dime-store stuff so he could give her genuine treasure.

Situation: A patient with chronic kidney disease but no history of heart disease came for lipid–lowering treatment. Dr Bad: There is no need. Dr Good: Go ahead with it. Lesson: Treatment with a combo pill – simvastatin/ezetimibe is associated with a 17% reduction in major atherosclerotic events and a 15% reduction in the risk of major vascular events, both compared with placebo, according to findings from the Study of Heart And Renal Protection (SHARP) trial.

Situation: A patient with Chikungunya had persistent joint pains. Reaction: Oh my God! Why was a trial of hydroxychloroquinine not given? Lesson: Make sure that all patients of Chikungunya fever with persistent joint pains are given a trial of hydroxychloroquinine.

Q. What are your views as regards prescribing of medicines by their generic names in place of trade names? Will this help a patient? What affect will it have on the Indian Medical scene?

Ans.

Prescribing of medicines by their generic names in place of trade names is a standard scientific approach. Physicians are required to prescribe by generic names as far as possible in terms of the MCI Regulations, 2002.

The practice of prescribing of medicines by their generic names in place of trade names will help the patient/public in the following ways:

The patient can easily find the indications, contraindications, side effects, toxic effects, dosage etc. in reference to the drug concerned from the internet. This will help him take the drug in a more responsible and correct and safe manner.

The patient will get better treatment from some other doctor at a latter time because the latter doctor would be better able to understand the nature of disease and the treatment given in the past. It is quite common for doctors to get confused in this matter because the same medicine may have dozens, scores or even more than a hundred brand names.

The patient will get more rational and scientific treatment. Doctors prescribing by brand names have often don’t have much idea about the real nature of the medicine. It also happens sometimes that the same medicine is prescribed at the same time under two brand names out of ignorance of the true nature of the generic compound in the brand drug. This can even be harmful.

The patient will get cheaper treatment. Generic drugs are much cheaper than branded drugs.

The effect on the Indian medical scene will be as follows:

Treatment will become less costly.

Doctors will become more knowledgeable.

Patients (consumers) will be more empowered and less likely to be taken for a ride.

The practice of offering/accepting gifts (bribes) among the pharma companies and doctors will decrease

Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Allergy testing

Allergies are hypersensitivities, overreactions of the immune system to substances that do not cause reactions in most people.

Allergen specific IgE testing: Immunoassay and line blot tests are blood tests used to screen for type I allergen–specific IgE antibodies.

You have a lighter and two fuses that take exactly one hour to burn, but they don't burn at a steady rate. For example, one fuse could take 59 minutes to burn the first inch and then burn the rest of the fuse in the last minute. How would you use these two fuses to measure 45 minutes?

Yesterday’s Mind Teaser: A boat has a ladder that has six rungs. Each rung is one foot apart. The bottom rung is one foot from the water. The tide rises at 12 inches every 15 minutes. High tide peaks in one hour. When the tide is at its highest, how many rungs are under water?

Answer for yesterday’s Mind Teaser: The boat is floating on the water, so as the tide rises, so does the ladder.

"The material we put into our stomachs should have killed most of us sitting here, years ago. Red meat is full of steroids and dye. Soft drinks corrode your stomach lining. Chinese food is loaded with MSG. High trans fat diets can be disastrous and none of us realizes the long-term harm caused by the germs in our drinking water. But, there is one thing that is the most dangerous of all and most of us have, or will eat it. Can anyone here tell me what food it is that causes the most grief and suffering for years after eating it?"

After several seconds of quiet, a 70–year–old man in the front row raised his hand, and softly said,

Government of India/Medical Council of India should give Statutory Rules or Executive Instructions on medical negligence – Supreme Court of India

The Honorable Apex Court said that so long as it is not done we propose to lay down certain guidelines for the future which should govern the prosecution of doctors for offences of which criminal rashness or criminal negligence is an ingredient.

A private complaint may not be entertained unless the complainant has produced prima facie evidence before the Court in the form of a credible opinion given by another competent doctor to support the charge of rashness or negligence on the part of the accused doctor.

The investigating officer should, before proceeding against the doctor accused of rash or negligent act or omission, obtain an independent and competent medical opinion preferably from a doctor in government service qualified in that branch of medical practice That doctor can normally be expected to give an impartial and unbiased opinion applying Bolam’s test to the facts collected in the investigation.

A doctor accused of rashness or negligence, may not be arrested in a routine manner simply because a charge has been leveled against him

The doctor should never be arrested in case of medical negligence since the basic rule of mens rea means any criminality to harm the patient always remain absent

The exceptional ground and necessity of arrest of doctor is required to be deliberated must be transparent/well justified before the police if unavoidable for furthering the investigation or for collecting the evidence or unless the investigation officer feels satisfied that the doctor proceeded against would not make him available to face the prosecution unless arrested, the arrest may be withheld.

The relative risk of coronary heart disease is 1.30 for each 200 mg increment of dietary cholesterol per 1000 kcal of energy intake.

Consumption of up to one egg per day (containing about 213 mg of cholesterol per egg) does not appear to substantially influence the risk of coronary heart disease or stroke among men and women without pre-existing diabetes mellitus or hypercholesterolemia.

However, people with diabetes and/or high cholesterol levels should restrict their intake of eggs. The white of an egg, on the other hand, is a pure protein and safe for consumption. Two whites of an egg can be substituted for every egg yolk for food preparations.

Readers Response

In the recent time I feel that the team work is lacking in the management of seriously ill patient ,it may be because of ego or lots of commercialization .We all must develop a team to manage such patient who need multispecialty treatment, any advices from the readers. Vivek Kumar, Varanasi